Provider Demographics
NPI:1801959077
Name:PALM HARBOR PEDIATRICS PA
Entity type:Organization
Organization Name:PALM HARBOR PEDIATRICS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:ENID
Authorized Official - Last Name:GAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-785-3092
Mailing Address - Street 1:2595 SR 584
Mailing Address - Street 2:SUITE W
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684
Mailing Address - Country:US
Mailing Address - Phone:727-785-3092
Mailing Address - Fax:727-786-1714
Practice Address - Street 1:2595 SR 584
Practice Address - Street 2:SUITE W
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684
Practice Address - Country:US
Practice Address - Phone:727-785-3092
Practice Address - Fax:727-786-1714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty